Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | R2171 | TX |
NPI | 1013275213 |
---|---|
Provider Name | Divya Mella |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75246-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 17/07/2019 |